1. The Field of the Invention
The present invention relates to systems providing services that assist healthcare providers to manage their provider location data and their specific patient population data along with the capability to submit healthcare claims via the Internet and receive back an indication of the claim resolution. More specifically, registered healthcare provider representatives enter claims via the Internet and interact with the system to correct any claim entry errors so that claims can be adjudicated real-time. The present invention allows registered healthcare provider representatives to construct their own customized superbill for claim entry or use the standard claim entry Web pages available in the system. The system provides a patient summary receipt so that the registered healthcare provider representative knows the correct co-payment or cost share to collect from the patient at the point of service. The patient summary receipt also indicates the amount the healthcare provider will be paid.
2. Description of Prior Art
The administration of insurance claims represents a significant overhead in the overall cost of health care. The introduction of computers and the Internet and the adoption of standardized procedure and diagnosis codes has facilitated the claim submission and adjudication process. Nevertheless, the reliance by insurers and other third party payors and by health care providers on customized claim forms often necessitates the re-entry of patient and provider information and can result in erroneous entries. As a consequence, payments are delayed and processing overhead is increased.
Numerous proposals have been made for using the Internet in the processing of insurance claims, for example, Eldridge et al., U.S. Patent No. US 2001/0037224 A1; Boyer et al., U.S. Pat. No. 6,208,973 B1; Bryant, Jr. et al., U.S. Patent No. US 2002/0169955 A1; Moore et al., U.S. Pat. No. 5,930,759; and Tarter et al., U.S. Pat. No. 5,704,044. Further suggestions have been made specific to health care claims. Boyer et al., U.S. Pat. No. 6,208,973 B1, shows the use of a credit card to facilitate point of service payment and suggests using the Internet to transmit information about claims so that they may be adjudicated in real time. In a system described by Provost et al., U.S. Patent No. US 2002/0091549 A1 and Provost et al., U.S. Pat. No. 6,341,265 B1 when a potential claim is adjudicated and found to be not covered, the system provides information about the reason the claim is not covered and is may suggest an alternative service or treatment. Peterson, et al., U.S. Pat. No. 6,343,271 B1 and Peterson et al., U.S. Patent No. US 2002/0019754 A1 show a system that allows doctors to access patient information from a central database.
None of the prior art systems observed allow health care providers using the system at the point of service to access centrally stored information customized specifically for their practice without the use of specialized hardware or software.